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HomeMy WebLinkAboutTR-7573A Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. BOx 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765~6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0699C Date: November 14, 2011 THIS CERTIFIES that the installation of roof moUnted photovoltaic solar system onto southerly roof of the dwelling At 9205 Bay Avenue, Cutchogue, New York Suffolk County Tax Map # 104-3-16.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated May 20, 2011 pursuant to which Trustees Administrative Permit #7573A Dated June 22, 2011 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of roof mounted photovoltaic solar system onto southerly roof of the dwelling The certificate is issued to ANTHONY & LYNDA LOMANGINO owner of the aforesaid property. Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765~6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1at day of construction ¼ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction % constructed Project complete, compliance inspection Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7573A Date of Receipt of Application: May 20, 2011 Applicant: Anthony & Lynda Lomangino SCTM#: 104-3-16.1 Project Location: 9205 Bay Avenue, Cutchogue Date of Resolution/Issuance: June 22, 2011 Date of Expiration: June 22, 2013 Reviewed by: Trustee Dave Bergen Project Description: To install roof mounted photovoltaic solar system onto the southerly roof of the dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by GreenLogic, LLC, received on May 20, 2011, and stamped approved on June 22, 2011. Special Conditions: None. Inspections: Final inspection and/or photographs of completed project. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jill(~l. Doherty, President Board of Trustees JMD:eac Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Brederaeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Please be advised that your application dated 1"7']~y, o?~ ~,¢2 I/ has been reviewed by this Board at the regular meeting of -- and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50,00) ~ Constructed ($50.00) ~( Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee rpust be paid within 90 days or.re-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$. BY: Jill M. Doherty, President Board of Trustees Jill M Doherty. President Bob Ghosio, Jr. Vice-lh-esident James F. King Dave Bergen John Bredemeyer P.O Box 1179 Southold. NY 11971 Telephone(631 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: GreenLogic LLC on behalf of ANTHONY & LYNDA LOMANGINO requests an Administrative Permit to install roof mounted photovoltaic solar system onto the southerly roof of the dwelling. Located: 9205 Bay Ave., Cutchogue. SCTM#104-3- 16.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound ~ Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~_Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: ~F('( ~-~ Present Were: __J. Doherty __B. Ghosio J. King_ J. Bredemeyer D. Dzenkowski other Form filled out in the field b~ Mailed/Faxed to: Date: ~D. Bergen, CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEllNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer Hghta to the certificate holder In lieu of such endorsement(s). PRODUCER comAcr.~uE: Brookhaven Agency, Inc. Brookhaven Agency, Inc. PHO. E ....... ~!.(631) 941-4113 I~F~:~. No,: (631) 941-4405 P.O. BOX 850 *nn~;=,='~=L brookhaven.agency~veHzon.net 150 Main Street PRODUCER East Setauket NY 11733 !~,,~s~ ~o~No c;pVERAa~ ~JC # ~NSU~O ~NSU~A= Torus Specialty Insurance Co. Greenlogic, LLC ~NSU;E~ a: Merchants Preferred Ins. Co. 425 County Road 39A, Suite 101 ~NSU.E; C: Utica National Southampton, NY 11968 INSURER D: iNSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. O_?E~L u~cm~ ~CH ~CURR~NCS $1~000,000 A X COMMERC~ALGENERALLIABILITY X 50817AIIOB 01/31/11 01131/12 CAM~eETO~NTEO PR~U,~;~ !; ..... ~ ~ 50,000 I o ,u OE [] OCCUR M;OEXP(^n¥om b,m o ) ;5,000 PERSO~ ~ ~V INJURY$ f ~000,000 -~ CONTRACTUAL LIAB eENE~AGGREO^~ S2,000~000 B X~ ~¥AUTO X CAPI043565 06/12/20~l 06/12/201(~d~.r) $1,000,000 $ X~ UMBRELLA U~ ~ OCCUR ~CH OCCURRENCE ~ 2~0001000 A EXC~SSLm~) m c~us-u~E X 508i7AI10A 01/31111 01/31112 )Ae~RE~E )2~000)000 X R~E~ %10,000 C Installation Floater CPP 4182553 1~30/10 1/30/11 $105~400 Ded $1,000 CEKT~P;CATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHOLD, NY 11971 Phone: Fax: SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) Greenlogic, LLC 425 County Road 39A Suite 101 Southampton, NY 11968 Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy) lb. Business Telephone Number of Insured (631)771-5152 lc. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Southold Building Dept. 53095 Route 25 Southold, NY 11971 or Social Security Number 20-3801194 3a. Name of Insurance Carrier New Hampshire Insurance Co 3b. Policy Number of entity listed in box "la" WC1602420 3c. Policy effective period 08/11/2010 -8/11/2011 3d. The Proprietor, Partners or Executive Officers are ~rl included. (Only check box if all partner~dofllcers Included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carder or its licensed agent will send this Certificate of Iusurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Thomas P. Terry. CPCU (Print name of authorized representative or licensed agent of insurance carrier) 08/03/2010 (Signature) (Date) Title: Authorized Renresentative Telephone Number of authorized representative or licensed agent of insurance carrier: (631) 283-8000 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C- 105.2 (9-07) www.wcb.state.ny.us This is to certify that ROBERT J SKYPALA doing business as GREENLOGIC LLC having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, roles and regulations of ' the County of Suffolk, State of New York. ' Additiol]al Businesses NOT VALID WITHOUT DEPARTMENTAL SEAL AND A CURRENT C~ONSUMER AFFAIRS ID CAI~D Director 104 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Date: June 21, 2011 Principal Planner LWRP Coordinator Re: Proposed Wetland Permit for ANTHONY & LYNDA LOMANGINO SCTM#1000-104-3-16.1 GreenLogic LLC on behalf of ANTHONY & LYNDA LOMANGINO requests an Administrative Permit to install roof mounted photovoltaic solar system onto the southerly roof of the dwelling. Located: 9205 Bay Ave., Cutchogue. SCTM#104-3-16.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "11" which states: II. Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage, except where the parcel is located in a coastal erosion hazard area; The proposed action is not located within a coastal erosion hazard area. Cc: Lori Hulse, Assistant Town Attorney Office Use Only Coastal Erosion Permit Application Wetland Permit Application X/ Administrative Permit ~Amend!ne~ffTransfer/E~tension ~_Completed Application ~ ]6101D __Incomplete __SEQRA Classification: Type l__Type I1 Unlisted Coordination:(date sent) ~ETWRP Consistency Assessment Form %{0131/I., __CAC Referral Sent: ~'N\ &- _~'Date of Inspection:~t ~] q __Receipt of CAC Report: ' ! __Lead Agency Determination:__ Technical Review: ~Public Hearing Held: I...~ !~,a) I~ __Resolution: Name of Applicant Address Suffolk County Tax Map Number: 1000- [OL~ - 0'~ ~ [~.1 Property Location: q?_O~ ~(LL{ ,,~O~,'l~°_ f~(A¥ 2 0 2011 $oulh (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: £[7..S COU,In.'~ ~ ~, Phone: Board of Trustees Application GENERAL DATA Land Area (in square £eet): t ')---'~t '~ ~_~.f~ Area Zoning: ~-.~,~tf'~z4_ 0d Previous use of property: ~'~ i ~ Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes ~ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: r:~_ ~Ag~' ( ~0 Qlh. la ~JNh t~l ~h,~ate Yes __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? k./ No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: I1~._~_1~ C~(5-~_a r" ?_~dS ~ Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? // No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: fool tova4 Are wetlands present within 1 O0 feet of the proposed activity? No [,// Yes Does the project involve excavation or filling? ~No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? ~J [~f (cubic yards) Manner in which material will be removed or deposited: ~/~ Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) PROJECT ID NUMBER PART t - PROJECT INFORMATION 1.APPLICANTISPONSOR /~1~.~1~"~(~ 617.20 APPENDIX C STATE ENV[RONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2, PROJECT NAME SEQR 3.PROJECT LOCATION: M unicipalibj ~ ~ PRECISE LOCATION: Street Addes, and Road In~ctk)~.~nt landmarks arc-or DrovJG~ mad DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres UItJmately acres 8. W1LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~_~[Yes ["'1 No If no, describe bdefly; 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) {~Resl~enUal r--Ilndustdal OCommerclal ~]Agriculture [--']Park/ForestlOpenSpaoa [---]Ol~er (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, S~ate or Local) I'}Yes ~No If yes, list agency name an(] permit I approval: 1 t. ODES ANy ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAl-? ~lYes [--~No If yes, list agency name and permit / approval: R ULT PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE iNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 6t7.47 If yes. coordrnale the review process end use the FULL FAF. B. WILL ACTION RECEIVE COORDIN^TED REVIEWASPROVIDEDFORUNLISTED^CTIONSIN6NYCRR, PART617.67 If No, anegative declaration may be superseded by another Involved agency. ~'--~ Yes [::]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Aaswers may be handwrirten, if legible) C1. Existing air quality, surface or groundwater qualify or quantity, no/aa levels, exla~g Iraff'~c pat[em, sol~ waste prnduclJon or disp<3sal, potengal for emsfon, dmlnnge or flooding problems? Explain briefly: C2. Aesthetic. ag ~if~llural, archaeo~ngical, hletorlc, or other nat~ml or cullutal m~o~mas; o~ community or neighboCtood characte~ Explain briefly: I ,,,,,,,I C3, Vegetation or f~luna, fish, shelll~h or wildlife species, signJf'~ant hah/tala, o~ threatened or endangered species? Explain briefly: I c4. ^ commun~¥s.~ p~n~ or g0am as omcm,y sdop~nd, or a c~ange ~. uso or Inmn~ty'of use of land o~'o~h~: ~at~nd fa=0~e~?'Exp~i~ ~pefl~ C5. G, rowth, subset, uent devek~pment, or related acti~ffies likely to be induced by the proposed action? Explain briefly: ......... C6. L~or~, te~m, ~h~t term, cun~Jlath~, or other e~ not ldentifted iA Cl-CS? Explain briefly: E NV~RONMENTAL AREA (CFA)? (If yes. explain bftsr~: E. IS THERE. OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: r--]No I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by AgencT) INSTRUCTIONS: F~reach~dver~ee~ectidenit~edab~ve~deten~inewhetheritiesubstantia~arge~imp~.tant~r~the~vises~gni~cant~ Each effect should be assessed in connec~on with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materiels. Ensure that explanations contain sufficient detail lo show that all ratsvant adveras impacts have been identified and adequately addressed. If question d of part ii was check<ed yes, the ~etorminadon of significance must evaluate the potential impact of the proposed a(~tien on the environmental characts~isitcs of the CEA. Chec~ this Pox if you have ideniffl ed one or more potan~ally large or sig n~lcant ndverse/mpa ets whicri MAY occur. Then pmceed directiy to the F UL FAF and/or prepare a positi~ dectsratfon, Check this box if you have determined, based on the information and analysla above and any supporting documentation, that the proposed WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppe~ting th/ petenmlnation. Name of Lead Agency Date Print or Type Name o/Respo*~eltile Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency $1tinatore of Preparer {if different from responsible oflfoer) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM SCOPEOFWO~ - PRO~S~ CON~U~ON ~ / WO~S~S~ ~ Y~ No ~n~n acUv~ im~ous su~.) {s.../--} 2 ~ the S~ Plan an~°r ~.ey ~ P~ ~ ~ ~ 3 Do~ ~e S~e Plan and/or Su~ey ~ ~e ~s~ COH~ OF ........................................... 0~ ~or ~pre~en~fiv~ of ~e 0~ or ~e~, ~d is duly au~o~ to p~o~ or ~ve ~ffo~d ~e ~d ~ ~d m · ~ ~e wo~ ~ be p~ffomed ~ ~e m~ner ~et fo~ in ~e app~on ~ed S~m to ~o~ me ~; FORM - 06/10 BARBARA A. CASCIOT] A N¢~ Public, State of New York No. 01-CA4894969 ~ualified In Suffolk Courtly ~l~ion Ex,ires May 11, ;~O/~'" coumy o£ Sui~lk Sta~ of'N~v¥ York DEPOS~ES AND AFI~RMS THAT HE/SH~ IS ~ APPLICANT FOR ~ A~ DE~ P~ ~ ~T ~ STA~ ~ ~ ~ ~UE TO ~ B~ ~ ~ ~W~E ~ ~, ~ ~T ~.~. W~ ~.~. BE ~ ~ ~ ~ 8~ ~ ~ ~S ~CA~N ~ AS ~Y BE ~PRO~D ~ ~ ~O~ ~ BO~ OF ~USI~S. ~.~CA~ AO~ TO HOLD T~ ~ OF ~D ~ ~ ~~i'~ · A~rHoRIzA'nON (wh~¢ ~he applic~n~ is n~ tl~ to apply for penn/tis) £,,,x, ~¢ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the ~art of town officers and emt~lovees. The tmroose of this form is to orovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entiiy, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% o£the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): __.A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this [ Signature Print Name Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfi'ont Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION scm# The Application has been submitted to (check appropriate response): TownBoard [] Planning Dept. [] Building Dept. ~-~ BoardofTrustees Category of Town of Southold agency action (check appropriate response): (a) (b) (c) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) Financial assistance (e.g. grant, loan, subsidy) Permit, approval, license, certification: Nature and extent of action: Site acreage: (99t [~ CA~_oJ~ Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: ~~ (b) Mailing address: C't"~O~ ~O'~0..ll ~ (c) Telephone number: Area Code (). (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No ~ If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ~Yes ~-] No [~otApplicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes [] No [~Not Applicable Attach additional sheets if necessa~ Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No ~/~ot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No [~Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [] Yes [] No [~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evalr~ criteri~· [] Yes [] No I~ Not Apphcable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No [~q~t Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes [] No I~;t Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] YeJ-~ No ~Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L/WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No [--~Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes [~ No [--~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section II1 - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [] No ~-~oot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~ No [~Not Applicable Created on 5/25/05 11.'20 AM i GREENLOGIC May 18, 2011 T ownofSouthold ~ {{~ [~ ~ ~ ~ own iL ii Building Department MAY 2 0 2011 Town Hall 53095 Route 25 S0u~hh01d Southold, NY 1197i Beard 0i Trustees Dear Trustees: Please find attached a building permit application on behalf of Anthony and Lynda Lomangino who have hired us to install a roof-mounted (flat to the roof) solar photovoltaic (PV) electric system for their house at 9205 Bay Avenue in Cutchogue. In connection with this application, please find attached: · Aapplications · 2 Transactional Disclosure Forms · 2 Short Environmental Assessment Forms · 2 LWRP ConsitencyAssessment fForms · 2 Surveys of Premises · 2 Engineer's Reports (2 originals and 2 copies) · 2 One Line Diagram · 2 Visios Diagram ofthe proposed system · 2 Spec. sheets of the solar panels (SunPower SPR-238 watts) · 2 Spec. sheets of the inverter (SunPower SPR3000m/4000m) · GreenLogic Suffolk County Home Improvement License · GreenLogic Certificate of Liability Insurance · GreenLogic Certificate of Worker's Compensation Insurance Coverage · Installation Manager's Master Electrician's License Please let us know if you need anything else in connection with this application. Yours truly, Alexandra McNear Senior Account Manager '~ ~ '~Gi~nlogi'c~l:C' ' .... : 7~1 $77 77] 4~30 F~x: 87/ /71 ,1320 SOUTHAMPTON'CORPORATE CUTCHOGUE: MANORVILLE: FIRE ISLAND: ROSLYN HEIGHTS ~00 S ' ' , Pacifico Engineering PC PO Box 1448 Sayville, NY 11782 www. pacificoengineering.com May 3, 2011 Town of Southold Building Department 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Subject: Solar Energy Installation for Anthony Lomangino ......... ~205..Bay AYe MAY 2 0 S0uthh01d T0w0 Board of Trustees Engineering Consulting Ph: 631-988-0000 Fax: 631-382-8236 engineer~paciflcoengineering.com APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD I have reviewed the roofing structure at the subject address. The structure can support the additional weight of the roof mounted system. The units are to be installed in accordance with the manufacturer's installation instructions. I have determined that the installation will meet the requirements of the 2010 NYS Building Code, and ASCET-05 when installed in accordance with the manufacturer's instructions. Roof Section A B mean roof height 19 ft 26 ft pitch 9 1/2 in112 4 1/4 in/12 roof rafter 2x10 2x10 rafter spacing 16 in OC 16 in OC Reflected roof rafter span 7.1 ff 11.4 ft Table R802.5.1( 1 ) max 20.6 ff 20.6 ft The climactic and load information is below: CLIMACTIC AND Ground Wind Live load, point GEOGRAPHIC DESIGN Category Snow Load, Speed, 3 pnet30 per pullout Fastener type CRITERIA pg sec gust, ASCE 7, mph psf load, lb Roof Section A C 20 120 33 348 5/16" dia screw, 4-112" B 62 650 5/18" dia screw, 4-1/2" Pacifico Engineering PC Ralph Pacifico, Professional Engineer NY Lic 066182 NJ Lic 24GE04744300 GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 PROJECTCOMPONENTCOUNT 6,66kW 28 Sunpower 238w UniRac Sunframe Azimuth =172° Pitch =38° Scale 3/16" = 1,0' Panel Dimension = 61.39"x31.42" Army Length = 245,56" Array Height = 98.76" Surface Dimensions =297"x135" Magic# = 32,17" A) Attachment type and count: 27 Standoffs B) Rail type and count: UniRac Sunframe ISSUES / SPECL~L tNSTRUCTIONS Sunpower 238w Attachment Point UniRac Sunframe t I 2×10"DouglasFir Rafters 16" On Center Layout Created By: MVP Date: 4-28-11 Pacifico Engineering PC PO BOX 1448, Sayvi~]e, NY 11782 Ralph Pacifico, ProfessionaJ Engineer NY Lic 066182 NJ Lic 24GE04744300 GreenLogic, LLC - Approved 6.66kW Layout 28 Sunpower 238w UniRac Sunframe Azimuth =172° Pitch =38° Scale 3/16" = 1.0' PROJECT COMPONENT COUNT A) Attachment type and count: 27 Standoffs Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 B) Rail type and count: UniRac Sunframe Panel Dimension = 61.39"x31,42" Lay?ut Created By: MVP Date: 4~28-11 -- ISSUES / SPECIAL INSTRUCTIONS Sunpower 238w Attachment Point UniRac Sunframe 2x10" Douglas Fir Rafters 16" On Center Array Length = 245,56" Army Height = 98.76" Surface Dimensions =297"x135" Magic # = 32.17" Pacifico Engineering PC Ralph Paciflco, Professional Engineer NY Lic 0~6182 NJ Lic 24GE04744300 GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 6,66kW 28 Sunpower 238w UniRac Sunframe Azimuth = 172° Pitch = 20° Scale 3/16" = PROJECT COMPONENT COUNT A) Attachment type and count: 23 Standoffs B) Rail type and count: UniRac Sunframe Panel Dimension = 61.39"x31,42" Array Length = 251.36" Army Height = 126.53" Surface Dimensions =310"x168" Magic # = 62,14" ISSUES / SPECIAL INSTRUCTIONS t6 Sunpower238w Sunpower 238w Attachment Point UniRac Sunframe 2x10' Douglas Fir Rafters 16" On Center Layout Created By: MVP Date: 4-28-11 Pacifico Engineering PC Ralph PacifieD, Professional Engineer NY Lic 066182 NJ Lic 24GE04744300 GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 PROJECT COMPONENT COUNT 6.66kW 28 Sunpower 238w UniRac Sunframe Azimuth = 172° Pitch = 20° Scale 3/16" = 1,0' A) Attachment type and count: 23 Standoffs Panel Dimension = 61,39"x31.42" Array Length = 251,36" ISSUES / SPECIAL INSTRUCTIONS 16 Sunpower 238w Sunpower 238w Attachment Point UniRac Sunframe t I 2xl0"DouglasFir Rafters 16" On Center Layout Created By: MVP Date: 4-28-11 B) Rail type and count: UniRac Sunframe Array Height = 126.53" Surface Dimensions =310"x168" MagiC # = 62.14" Pacifico Engineering PC 631-988-O000 Ralph Paciflco, Professional Engineer NY Lac 066182 NJ Lic 24GE04744300 Framing: 2x12 Micro-Lam Ridge. 2x10 Douglas Fir rafters spanning 14'5", spaced 16" on center. 2xl 0 Douglas Fir Collar Ties/Ceiling joists spaced 16" on ce~er, down 2'6" from ridge. 2x6 Douglas Fir exterior wall =/?' Pl,jwood sheathing. 1' Overhang. GreenLogic, LLC - Approved 6.66kW Layout 28 Sunpower 238w UniRac Sunframe Lomangino, Anthony Azimuth = 172° 9205 Bay Ave Pitch = 20° Cutchouge, NY 11935 Scale 3t16"= 1.0' PROJECT COMPONENT COUNT A) Attachment type and count: 23 Standoffs B) Rail type and count: UniRac Sunframe Panel Dimension = 61.39"x31.42" Array Length = 282.78" Array Height = 126.53" Surface Dimensions =310"x168" Magic # = 62.14" ISSUES / SPECIAL INSTRUCTIONS Sunpower 238w Attachment Point UniRac Sunframe t I 2xl0"DouglasFir Rafters 16" On Center 18 Sunpower238w Pacifico Engineering PC Ralph Pacifico, Professional Engineer NY Lic 066182 NJ Lic 24GE04744300 Framin§: 2x12 Micro-Lam Ridge, 2×10 Douglas Fir rafter spannir~j 11'3", spaced 16" on center 2×10 Douglas Fir Collar Ties/Ceiling joist~ spaced 16" on center, 22" down from ridge 2x6 Douglas Fir exterior wall spaced 1 B" on ce~er %" Plywood sheathing~ 2' Overhang. GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 6.66kW 28 Sunpower 238w UniRac Sunframe Azimuth =172° Pitch =38° Scale 3/16" = 1.0' PROJECT COMPONENT COUNT A) Attachment type and count: 27 Standoffs B) Rail type and count: UniRac Sunframe Layout Created By: MVP Date: 4-28-11 Panel Dimension = 61.39"x31.42" Array Length = 245.56" Array Height = 98.76" Surface Dimensions =297"x135" Magic # = 32.17" ISSUES/SPECIAl-INSTRUCTIONS -- Sunpower 238w Attachment Point UniRac Sunframe I I 2xl0"DouglasFir Rafters 16" On Center 24O VAC 240 VAC FF ERGY GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 PROJECTCOMPONENTCOUNT 6.66kW 28 Sunpower 238w UniRac Sunframe Azimuth = 172° Pitch = 20° Scale 3/16" = 1.0' Panel Dimension = 61.39"x31.42" Array Length = 251.36" Array Height = 126.53" Surface Dimensions =310"x168" Magic # = 62.14" ISSUES / SPECIAL INSTRUCTIONS Sunpower 238w Attachment Point UniRac Sunframe I I 2xl0"DouglasFir Rafters 16" On Center A) Attachment type and count: 23 Standoffs B) Rail type and count: UniRac Sunframe 16 Sunpower 238w Layout Created By: MVP Date: 4-28-1t LOG)C® GreenLogic, LLC - Approved Layout Lomangino, Anthony 9205 Bay Ave Cutchouge, NY 11935 PRO.IECT COMPONENT COUNT i 6.66kW 28 Sunpower 238w UniRac Sunframe Azimuth =172° Pitch =38° Scale 3/16" = 1.0' A) Attachment type and count: 27 Standoffs B) Rail type and count: UniRac Sunframe Panel Dimension = 61,39"x31.42" Array Length = 245.56" Array Height = 98.76" Surface Dimensions =297'x135" Magic # = 32~17" ISSUES / SPECIAL INSTRUCTIONS Sunpower 238w Attachment Point UniRac Sunframe I 1 2xl0"DouglasFir Rafters 16" On Center Layout Created By: MVP Date: 4-28-11 SER~ES The SunPowerTM 238 Solar Panel provides today's highest efficiency and performance. Utilizing 72 all back-contact solar cells, the SunPower 238 delivers a total panel conversion efficiency of 19. 1%. The panel's reduced voltage-temperature coefficient, anti-reflective glass and exceptional Iow-light performance attributes provide outstanding energy delivery per peak power watt. 20% 15% 10% 5% 0% SunPower's High Efficiency Advantage 14% 10% Thin Film Conventional SunPower SunPower E18 Series E19 Series E~Wica Data Peak Power 1+5/-3%) Pmax 238 W ~fficiency q 19 ] % Rated Voltage Vmpp 405 V Rated Current Jmpp 5.g8 A Open Circuit Voltage Voc 48 5 V Short Circulf Current Isc 6 25 A Mc=x(mum System Vollage UL 600 V l~mperature Coefficients Power (Pi -038% / K Voltage (Voc) Q 325mV / K Current {Isc) 3 5mA / K NOCT 450 C +/-2~ C Series Fuse Rating 20 A MeChanical Data Solar Cells Front Gbss Junction Box Output Cables Frc~me Weight 72 SunPower all'ack contact monocrystalline High transmission tempered glass wi~h anti-reflective (AR) coating IP-65 rated with 3 bypass diodes Dimensions: 32 x 155 x 128 Imm) ]O00mm length cabbs / MultiContact (MC4) connectors Anodized abminum alloy type 6063 Ibbck) 33] ]bs~ (15.0 kg) Dimensions I-V Curve 7,0 4,0 3~0 0 10 20 30 40 50 60 Voltage (V) Max load Impact Resistance Certifications Tested Operating Conditions -40~ F to +185° F (40" C to + 85° C) 113 psi 550kg/m~ (5400 Pa) fronl - e.g snow; 50 pst 245kg/m~ (2400 Pa) front and back - e.g. wind Hail 1 in (25 mm) at 52mph (23 m/s) Warranties and Certifications 25 year limited power wcm'anty 10 year limited product warranty Tested to UL 1703~ Class C Fire Rating SunPowerTM 3000m and 4000m Inverters offer exceptional reliability and superior performance. Innovative design and advanced testing are combined to create a durabJe inverter for optimal system performance over the long term. Both models are backed by a standard t O-year warranly. sunpowercorp.com 1-800-SUNPOWER SPR-3OOOm SPR-4000m 3500 W @ 208 V / AC Power 30oo w AC Maximum l@ 208v, 240v) AC CEC Welghl~J Efficiency 950 % @ 2o8 v 955 % @ 2o8 v Power {DC @ STCJ 50oo w @ 240 v 100 SPRm Efficiency Curves 7O % of Rated Output Power Mechanical Data Shipping Dimenslons W x H x D (inchesJ 235~x 185~x 160* Unit Dimensions W x H x O {inches) 178' × 138" x 93' Inverter Weight 88 lbs Shipping Weight 94 Peak Power Tracking Voltage DC Max. Input Curr~ent DC Voltage Ripple No. of Fused String Inputs Standby / Nighttime Certifications Warranty and Certifications About SunPower Founded in 1985, SunPower Corp. {Nasdaq: SPWRA, SPWRB) designs, manufactures and delivers the planet's most powerful solar technology broadly available today. Residential, business, government and utiJih/customers rely on the company's experience and proven results to maximize return on investment. HOC, NECK BAY ............................. I~AY 2 0 2( Southhold To~ Beard et Trustee × pRoPOSED 2-I/2 S'T~, S-1 · -%2-:.....z ..: AS BY 100. Oo, ~'OLO C~4A,~EL 81"49'40,, W S 87 01/2u . · -': 2.5 00' " BAy AVeNUe; DWELLING (USES PUBLIC WATER) ~IOIF DONALD J, BALL ~¢ ELLEN E. BALL eo~e. uos. S 84'15'50" W 154,95' (N 841350" W SURVEY OF PROPERTY SITUATE PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104-05-16.1 SCALE 1"--,30' FEBRUARY 21, 2005 AUGUST 25, 2009 LOCATED WETLANDS AREA = 123,706 sq. ff. (TO TIE LINES) 2.8~-0 ac. 0 ~ 5' 179.2 suRVEY DATED 5/24/59) DWELLING (USES pUBLIC WATER) ~/o/~ CERTIFIED TO: FOR THE LOVE OF FAMILY, LLC SKY LINE TITLE OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY NOTES: 1, ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:~~ 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP Ne. $6105C0164 G ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE VE: CGASTAL FLOOD WITH VELOCI~( HAZARD (WAVE ACTIDN); BASE FLOOD ELEVATIONS DETERMINEO ZONE X : AREAS OF 5GO-YZAR FLOOD; AREAS OF 100-yEAR FLOOD WITH AVERAGE DEP11H OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED DY LEVEES PROM 1GO-YEAR FLOOD. TEST HOLE DATA 12' THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF N.Y.S. Uc. No, 50467 Nathan Taft Corw n II! Land Surveyor PHONE (631)727-2090 OFFICES LOCATED AT 1586 Main Road Jame~pa~, New York 11947 Fox (551)727-1727